My Patients Suffer When You Doubt Their Mental Illness

Dr. Diane McIntosh
Psychiatrist and clinical assistant professor at the University of British Columbia

Hinterhaus Productions via Getty Images

Lonesome senior woman sitting at her bed in retirement home.

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As a psychiatrist, I have a privileged role in the lives of my patients. Because of my education and experience, they trust me to guide them back to wellness.

Sadly many of my patients are injured by the widespread denial in our society that mental illnesses are really illnesses. I have felt the burden of the powerful anti-psychiatry movement in my practice for many years.

However, it wasn't until recently that I learned the extent of its reach and how political correctness has allowed this anti-science movement to infiltrate mental health services across North America.

We lack adequate mental health education and resources, and as we have seen in other contexts, lack of services and lack of mental illness literacy results in the growth of fringe thinking.

This thinking is attractive to those who feel alienated and misunderstood. Mental health patients are particularly vulnerable, because their illness is often hidden and experienced as a shame.

We don't celebrate recovery from an episode of mental illness like we do when someone "survives" cancer. We don't adequately fund innovative mental health research and development, and thus we are decades behind, from a community health perspective, when we compare mental health care to other areas of health education, prevention and treatment.

I have hundreds of examples of the ignorance my patients face, which creates a sometimes insurmountable barrier to their recovery. I'd like to share one of those stories. While my patient was keen that I tell her story, I have changed her name and some details to protect her privacy.

Lillian is 75 years old and I have been her psychiatrist for a decade. She's feisty, quirky and independent. She also has bipolar disorder, she's a recovered alcoholic and she has diabetes.

When I met her, she had severe depression, she was essentially house-bound in a filthy apartment, socially isolated and estranged from her family. She slept all day and was awake all night. Her diabetes was out of control.

Over the next few years we worked together to stabilize her mood, sort out her medication and get her back to life. There were certainly challenges due to side effects and some treatments we tried didn't work, but she trusted me to guide her and slowly she emerged from the darkness that had enveloped her for so long.

She cleaned her apartment and resumed relationships with family and friends. She took art and dance classes and started to volunteer. Her diabetes was finally well-controlled. Lillian said she finally had a reason to get up in the morning.

And then suddenly it all fell apart. I didn't see her for a few months, and after a missed appointment, I called her to see if she was okay. She said she wasn't; she was depressed. She couldn't think of anything that would cause the terrible sadness to return. There was no major stress in her life and she assured me she was taking her medication.

However, her pharmacy confirmed she hadn't been picking up her medication on time. She sheepishly admitted she'd stopped taking her medications three months before, soon after she had been discharged from a hospitalization for pneumonia.

Lillian finally told me that the in-patient doctor had quipped, "You're on too much medication." The doctor hadn't elaborated on what she meant by "too much," nor did she call me or Lillian's GP to ask for the treatment rationale or to express concern.

I'm angry at those who see no value in the years of education psychiatrists must complete, at those who ignore or dismiss scientific evidence, and see themselves as self-appointed experts on mental health.

It was just a passing comment, but those words powerfully undermined Lillian's confidence and stirred up her long-held fear that her illness was a weakness or personal failure.

She thought that she should be able to get over it on her own and she shouldn't need to rely on medications. She feared that medications might be causing more harm than good, even though she felt better.

In the span of a few seconds, five words undid years of hard work. Once again she was depressed, anxious, unable to sleep properly and withdrawn from family, friends and her community. So we began again, restarting her medications one by one, and over the next year Lillian slowly re-emerged from the darkness and started to function again.

And then a girlfriend at lunch said, "You don't need those medications," and that was all it took. Lillian stopped them again. I asked if she was experiencing intolerable side effects. Did she believe they weren't helping? Was cost prohibitive?

She assured me she had no side effects, the cost was fully covered by her health plan, and she knew they were helpful. Yet she still stopped them and suffered the consequences.

This has happened three times over the last seven years, always following a simple, arrogant, misinformed, potentially deadly comment that essentially boiled down to, "You're not ill. You don't need treatment. I know better than your doctor."

Lillian knew none of those things were true, and yet the persistence of her own fears, fueled by those insensitive comments, were too powerful for her to ignore.

It's difficult for my patients to put their trust in me when they're inundated by anti-psychiatry messages. As a result, Lillian suffers, and with each relapse she fails to recover her previous level of functioning and her medical health declines.

To help her to recover again I have to see her more often, and as a result others go without psychiatric care. This makes me really angry, but not with Lillian. I see her as a victim of all those who think they know what is best for her and know more than her doctor.

I'm angry at those who see no value in the years of education psychiatrists must complete, at those who ignore or dismiss scientific evidence, and see themselves as self-appointed experts on mental health.

These people hurt my patients and further burden our already overburdened psychiatric services. As a physician, but also as human being, I have actually taken the time to learn, listen and act. These people don't. They deny, preach and cause tremendous harm.

Despite my best efforts, encouragement and attempts to educate my patients and their families, the anti-education, anti-science and unethical anti-psychiatry movement often prevails, to the detriment of my patients and society as a whole.